Differential Diagnosis
Syphilis: Syphilis is a systemic disease that presents as a chancre or a shallow ulcer in the primary stages of infection in women. The symptoms in the secondary stage of the infection may be exacerbated, presenting as generalized lymphadenopathy, malaise, symmetrical maculopapular rash, headache, and fever. There intermittent periods of active infection and latency. Latency periods develop following treatment, during which the patient’s gynecological exam may be normal (Hook, 2017). Since the patient’s exam is unremarkable besides the painless sore, syphilis would the primary diagnosis.
Genital Herpes: The condition is caused by herpes simplex virus (HSV) and often presents with symptoms such as headache, fever, painful genital ulcers, and dysuria. The condition occurs in stages, with symptoms being entirely asymptomatic, mild, or subclinical (Kent, 2017). The degree of pain tolerance among patients varies, and thus, it may be difficult to accurately determine whether a sore is painless. The gynecological exam for asymptomatic patients may be normal to unremarkable, making herpes a possible diagnosis for the patient.
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Pityriasis Rosea: An idiopathic condition characterized by an acute, self-limiting, papulosquamous rash on the chest, abdomen, genitalia, or back. The rash may be associated with certain types of a viral infection such as HSV, and may thus be a co-occurring infection with latent, asymptomatic genital herpes. The rash may be benign, oval, or circular. Given that the condition is idiopathic, accurate physical examination and laboratory diagnosis may be difficult.
Treatment Plan
Syphilis is a bacterial infection caused by the spirochete Treponema pallidum. Antibacterial agents are, therefore, the preferred treatment drugs for the condition. A single dose of intramuscular injection of Penicillin G benzathine 2.4 million units would be the most appropriate treatment for the patient during the visit (Hook, 2017). If the patient is allergic to penicillin, the next treatment alternative would be Doxycycline 100 mg tables, administered for two weeks. Other treatment alternatives for syphilis are a combination of amoxicillin 3g and probenecid 500mg, both administered orally twice daily for 14 days, and Tetracycline 500mg administered orally four times daily for 14 days ( Workowski & Bolan, 2015).
The treatment follow-up plan involves periodic laboratory examinations for VDRL to assess the patient’s response to treatment. The patient should also be made aware of the possible side effects of the treatment. With penicillin administration, the patient is likely to experience Jarish-Herheimer reaction, which is characterized by symptoms such as headache, fever, chills, nausea, and malaise ( Workowski & Bolan, 2015). The reaction is usually transient and resolves in about a day.
Strategies for Education on STIs
Sex education is aimed to curb the spread of STIs. It involves creating awareness on the importance of screening, safe sex practices, and adherence to treatment following diagnosis. Patient education at during the hospital visits is the primary method of sex education. During the physician-patient interaction, the physician gets to inform the patient of the possible causes of their condition, symptoms, and ways of treatment and prevention measures (Thompson, 2019). This adequate information ensures that the patient adheres to their medication, increasing the rate of recovery and thus limiting the chances of transmission to healthy individuals.
The media is another important channel for publicly relaying awareness on STIs. Physicians and public health officials have the responsibility of ensuring that information pertaining to the spread and prevention of STIs is publicly available. Social media campaigns against STIs are essential in creating this awareness. During these campaigns, the medical practitioners emphasize the need for being proactive in curbing the transmission of infection. Safe sex practices such as the use of protection, faithfulness, and abstinence are primary constructs of the education campaign (Thompson, 2019). The patients should know how the diseases are transmitted, the symptoms of the disease, and the importance for screening and early diagnosis.
References
Hook, E. W. (2017). Syphilis. The Lancet , 389 (10078), 1550-1557.
Kent, B. N. (2017). Sexually Transmitted Diseases: Prevalence, Treatment, and Diagnostics. American Society for Clinical Laboratory Science , 30 (2), 112-113.
Thompson, D. (2019). Increasing awareness of sexually transmitted infection through education: A quality improvement initiative.
Workowski, K. A., & Bolan, G. A. (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports , 64 (RR-03), 1.
